I have seen on several occasions men who have low testosterone levels who are on hormone replacement therapy and yet fail to improve their libido, energy level, or their erections.
One explanation is that some of the testosterone is converted to estrogen which is the female hormone. If men fail to respond to testosterone replacement therapy for low testosterone, then it is important to check the estrogen level (estradiol) and if this is elevated then the man will need to add an estrogen lowering medication, commonly Arimidex (anastrozole). It’s from the class of medications called aromatase inhibitors, which essentially block the conversion of testosterone to estrogen.
It helps by forcing testosterone output to remain high while keeping estrogen levels low. The dosage is 0.25mg every third day.
Bottom Line: anastrozole therapy, given over 12 months, significantly increased serum testosterone and modestly reduced E2 levels in men 60 years of age and older with mild-to-moderate hypogonadism. Aromatase inhibitors intervention resulted in the restoration of testosterone levels into the mid-normal range with improvement of the symptoms of low testosterone.